Impact of diabetes among revascularized patients in Japan and the U.S.

Shun Kosaka, Masashi Komeda, Masashi Goto, Ryuzo Sakata, Toshiyuki Nagai, Mitsuru Ohsugi, Vei Vei Lee, Keiichi Fukuda, Macarthur Elayda, James M. Wilson, Yutaka Furukawa, Toru Kita, Masanori Fukushima, Takeshi Kimura

Research output: Contribution to journalArticle

5 Citations (Scopus)

Abstract

OBJECTIVE - Approximately 25% of patients who undergo percutaneous coronary intervention (PCI) or coronary artery bypass grafting (CABG) have diabetes, and the diagnosis of diabetes roughly doubles the mortality risk associated with coronary artery disease. However, the impact of diabetesmay differ according to ethnicity.Our objective was to examine the impact of diabetes on long-term survival among U.S. and Japanese patients who underwent PCI or CABG. RESEARCH DESIGN AND METHODS - For the current analysis, we included 8,871 patients from a Japanese multicenter registry (Coronary Revascularization Demonstrating Outcome database in Kyoto; median follow-up 3.5 years; interquartile range [IQR] 2.6-4.3) and 7,229 patients from a U.S. multipractice registry (Texas Heart Institute Research Database; median follow-up 5.2 years; IQR 3.8-6.5). RESULTS - Diabetes was more prevalent among Japanese than U.S. patients (39.2 vs. 31.0%; P<0.001). However, after revascularization, long-term all-cause mortality was lower in diabetic Japanese patients than in diabetic U.S. patients (85.4 vs. 82.2%; log-rank test P = 0.009), whereas it was similar in nondiabetic Japanese and U.S. patients (89.1 vs. 89.5%; P = 0.50). The national difference in crude mortality was also significant among insulin-using patients with diabetes (80.8 vs. 74.9%; P = 0.023). When long-term mortality was adjusted for known predictors, U.S. location was associated with greater long-term mortality risk than Japanese location among nondiabetic patients (hazard ratio 1.58 [95%CI 1.32-1.88]; P<0.001) and, especially, diabetic patients (1.88 [1.54-2.30]; P < 0.001). CONCLUSIONS - Although diabetes was less prevalent in U.S. patients than in Japanese patients, U.S. patients had higher overall long-term mortality risk. This difference was more pronounced in diabetic patients.

Original languageEnglish
Pages (from-to)654-659
Number of pages6
JournalDiabetes Care
Volume35
Issue number3
DOIs
Publication statusPublished - 2012 Mar

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Japan
Mortality
Percutaneous Coronary Intervention
Coronary Artery Bypass
Registries
Databases
Coronary Artery Disease
Research Design
Insulin

ASJC Scopus subject areas

  • Internal Medicine
  • Endocrinology, Diabetes and Metabolism
  • Advanced and Specialised Nursing

Cite this

Kosaka, S., Komeda, M., Goto, M., Sakata, R., Nagai, T., Ohsugi, M., ... Kimura, T. (2012). Impact of diabetes among revascularized patients in Japan and the U.S. Diabetes Care, 35(3), 654-659. https://doi.org/10.2337/dc11-1547

Impact of diabetes among revascularized patients in Japan and the U.S. / Kosaka, Shun; Komeda, Masashi; Goto, Masashi; Sakata, Ryuzo; Nagai, Toshiyuki; Ohsugi, Mitsuru; Lee, Vei Vei; Fukuda, Keiichi; Elayda, Macarthur; Wilson, James M.; Furukawa, Yutaka; Kita, Toru; Fukushima, Masanori; Kimura, Takeshi.

In: Diabetes Care, Vol. 35, No. 3, 03.2012, p. 654-659.

Research output: Contribution to journalArticle

Kosaka, S, Komeda, M, Goto, M, Sakata, R, Nagai, T, Ohsugi, M, Lee, VV, Fukuda, K, Elayda, M, Wilson, JM, Furukawa, Y, Kita, T, Fukushima, M & Kimura, T 2012, 'Impact of diabetes among revascularized patients in Japan and the U.S.', Diabetes Care, vol. 35, no. 3, pp. 654-659. https://doi.org/10.2337/dc11-1547
Kosaka, Shun ; Komeda, Masashi ; Goto, Masashi ; Sakata, Ryuzo ; Nagai, Toshiyuki ; Ohsugi, Mitsuru ; Lee, Vei Vei ; Fukuda, Keiichi ; Elayda, Macarthur ; Wilson, James M. ; Furukawa, Yutaka ; Kita, Toru ; Fukushima, Masanori ; Kimura, Takeshi. / Impact of diabetes among revascularized patients in Japan and the U.S. In: Diabetes Care. 2012 ; Vol. 35, No. 3. pp. 654-659.
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AU - Kosaka, Shun

AU - Komeda, Masashi

AU - Goto, Masashi

AU - Sakata, Ryuzo

AU - Nagai, Toshiyuki

AU - Ohsugi, Mitsuru

AU - Lee, Vei Vei

AU - Fukuda, Keiichi

AU - Elayda, Macarthur

AU - Wilson, James M.

AU - Furukawa, Yutaka

AU - Kita, Toru

AU - Fukushima, Masanori

AU - Kimura, Takeshi

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N2 - OBJECTIVE - Approximately 25% of patients who undergo percutaneous coronary intervention (PCI) or coronary artery bypass grafting (CABG) have diabetes, and the diagnosis of diabetes roughly doubles the mortality risk associated with coronary artery disease. However, the impact of diabetesmay differ according to ethnicity.Our objective was to examine the impact of diabetes on long-term survival among U.S. and Japanese patients who underwent PCI or CABG. RESEARCH DESIGN AND METHODS - For the current analysis, we included 8,871 patients from a Japanese multicenter registry (Coronary Revascularization Demonstrating Outcome database in Kyoto; median follow-up 3.5 years; interquartile range [IQR] 2.6-4.3) and 7,229 patients from a U.S. multipractice registry (Texas Heart Institute Research Database; median follow-up 5.2 years; IQR 3.8-6.5). RESULTS - Diabetes was more prevalent among Japanese than U.S. patients (39.2 vs. 31.0%; P<0.001). However, after revascularization, long-term all-cause mortality was lower in diabetic Japanese patients than in diabetic U.S. patients (85.4 vs. 82.2%; log-rank test P = 0.009), whereas it was similar in nondiabetic Japanese and U.S. patients (89.1 vs. 89.5%; P = 0.50). The national difference in crude mortality was also significant among insulin-using patients with diabetes (80.8 vs. 74.9%; P = 0.023). When long-term mortality was adjusted for known predictors, U.S. location was associated with greater long-term mortality risk than Japanese location among nondiabetic patients (hazard ratio 1.58 [95%CI 1.32-1.88]; P<0.001) and, especially, diabetic patients (1.88 [1.54-2.30]; P < 0.001). CONCLUSIONS - Although diabetes was less prevalent in U.S. patients than in Japanese patients, U.S. patients had higher overall long-term mortality risk. This difference was more pronounced in diabetic patients.

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